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antibiotic resistance

Also see antibiotic sensitivity Etiology: organisms posing risk - tier 1 from WHO (highest priority, critical) [15] - Acinetobacter baumannii - Pseudomonas aeruginosa - extended-spectrum beta-lactamase-producing Enterobacteriaceae - tier 2 from WHO [15] (high) - Enterococcus faecium resistant to vancomycin - MRSA & vancomycin-resistant Staphylococcus aureus - Helicobacter pylori resistant to clarithromycin - Campylobacter species resistant to fluoroquinolone - Salmonellae resistant to fluoroquinolone - Neisseria gonorrhoeae resistant to cephalosporin & fluoroquinolone - tier 3 from WHO [15] (medium) - Streptococcus pneumoniae not susceptible to penicillin - Haemophilus influenzae resistant to ampicillin - Shigella species resistant to fluoroquinolone - top 3 from CDC [3] - carbapenem-resistant Enterobacteriaceae - Clostridium difficile - drug-resistant Neisseria gonorrhoeae - others from CDC[3] - multidrug-resistant Acinetobacter - multidrug-resistant Pseudomonas aeruginosa - fluconazole-resistant Candida - extended spectrum beta-lactamase producing Enterobacteriaceae - vancomycin-resistant Enterococcus - 30% of Enterococcus isolates are vancomycin-resistant [12] - methicillin-resistant Staphylococcus aureus - 50% of Staphylococcus aureus isolates methicillin-resistant [12] - drug-resistant Campylobacter, non-typhoidal Salmonella, Salmonella Typhi, Shigella, & Streptococcus pneumoniae - 70% of Salmonella typhi resistant to fluoroquinolones [7] - 25% of Campylobacter resistant to ciprofloxacin [7] - colistin-resistant enteric bacteria [11] antibiotic resistance associated with - 1 in 6 central line-associated bloodstream infections - 1 in 7 surgical site infections - 1 in 10 catheter-associated UTIs [12] - antidepressants can facilitate antibiotic resistance [22] (see Pathology:) Epidemiology: - World leaders at United United begin collective effort to reduce antimicrobial resistance [14] - 44,000 deaths in U.S, 2013 due to antibiotic-resistant organisms [20] Pathology: - antidepressants may kill or slow growth of certain bacteria [22] - they trigger an 'SOS' response initiating cellular defense mechanisms that lead to antibiotic resistance [22] - bacteria generate reactive oxygen & activate the bacteria's efflux pumps [22] - exposure of E. coli (& probably other bacteria) to antidepressants leads to an increase mutation rate with selection for antibiotic-resistance genes [22] Laboratory: - culture & sensitivity studies have slow turnaround leading to administration of empiric antibiotic therapy until results are available - diagnostics that rely on bacterial movements, genomics & machine learning may provide a much faster turn-around time [21] Management: - standard infection control procedures - handwashing - contact precautions - disinfection of environment & patient care devices - judicious use of antibiotics [13] - multidrug-resistant Pseudomonas aeruginosa - ceftolozane tazobactam [23] - consider adding once-daily tobramycin or amikacin for pyelonephritis [23] - carbapenem-resistant Enterobacterales - ceftazidime-avibactam in combination with aztreonam [23] - Carbapenem-resistant Acinetobacter baumannii - durlobactam sulbactam in combination with meropenem or imipenem-cilastatin [23] - Stenotrophomonas maltophilia - cefiderocol (with a second agent) - ceftazidime-avibactam & aztreonam, - minocycline (with a second agent) - trimethoprim-sulfamethoxazole (with a second agent) - levofloxacin (with a second agent) - igecycline is no longer listed as a component of combination therapy Notes: - antibiotic resistance to monotherapy for otitis media, upper respiratory tract infection, lower respiratory infection, or skin & soft tissue infections is ~15% (2012) [9] - interactive tool from CDC that contains antibiotic resistance data from bacteria isolated from humans as part of the National Antimicrobial Resistance Monitoring System (NARMS) [12] - topical fusidic acid & mupirocin may lead to selection of multidrug-resistant Staphylococcus aureus isolates [19] - antibiotic resistance genes have spread into the coastal aquatic ecosystems in China - described as medical equivalent of global warming - recognition of this issue by the United Nations [17] - of 51 new antibiotics & biologicals developed to treat high- priority resistant pathogens, tuberculosis, & C difficile, only 8 are innovative & will add value to the current antibiotic treatment arsenal [18] - for resistant isolates of enteric bacteria, report to EntericBacteria@cdc.gov

Related

antibiotic prescribing practices; antibiotic overuse; outpatient parenteral antibiotics antimicrobial stewardship

Specific

antibiotic resistance in nursing homes

General

drug resistance

References

  1. Napravnik S, Edwards D, Stewart P, Stalzer B, Matteson E, Eron JJ Jr. HIV-1 drug resistance evolution among patients on potent combination antiretroviral therapy with detectable viremia. J Acquir Immune Defic Syndr. 2005 Sep 1;40(1):34-40. PMID: 16123679
  2. Strasfeld L, Chou S. Antiviral drug resistance: mechanisms and clinical implications. Infect Dis Clin North Am. 2010 Sep;24(3):809-33. PMID: 20674805
  3. Centers for Disease Control and Prevention (CDC) Antibiotic/Antimicrobial Resistance: Threat Report 2013. http://www.cdc.gov/drugresistance/threat-report-2013/
  4. Laxminarayan R et al Antibiotic resistance - the need for global solutions. The Lancet Infectious Diseases, Dec. 2013. 13(12):1057-1098 PMID: 24252483 http://www.thelancet.com/journals/laninf/article/PIIS1473-3099(13)70318-9/abstract
  5. FDA News Release: Wed. Dec. 11, 2013 FDA takes significant steps to address antimicrobial resistance. Agency implementing plan to ensure judicious use of antibiotics in food animals. http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm378193.htm
  6. World Health Organization (WHO), April 20, 2014 WHO's first global report on antibiotic resistance reveals serious, worldwide threat to public health. http://www.who.int/mediacentre/news/releases/2014/amr-report/en/ - World Health Organization (WHO) Antimicrobial Resistance, Global Report on Surveillance. 2014. http://apps.who.int/iris/bitstream/10665/112642/1/9789241564748_eng.pdf
  7. National Antimicrobial Resistance Monitoring System The 2012 NARMS Annual Human Isolates Report CDC NARMS tracks antimicrobial resistance in Salmonella and other enteric (intestinal) bacteria that may cause mild or severe diarrhea or bloodstream infection. http://www.cdc.gov/narms/reports/annual-human-isolates-report-2012.html
  8. The White House. Sept 18, 2014 Executive Order -- Combating Antibiotic-Resistant Bacteria http://www.whitehouse.gov/the-press-office/2014/09/18/executive-order-combating-antibiotic-resistant-bacteria - Executive Office of the President. President's Council of Advisors on Science and Technology. September 2014. Report to the President on Combating Antibiotic Resistance. http://www.whitehouse.gov/sites/default/files/microsites/ostp/PCAST/pcast_carb_report_sept2014.pdf
  9. Currie CJ et al Antibiotic treatment failure in four common infections in UK primary care 1991-2012: longitudinal analysis BMJ 2014;349:g5493 PMID: 25249162 http://www.bmj.com/content/349/bmj.g5493?etoc=
  10. The White Hours. Office for the Press Secretary. March 27, 2015 FACT SHEET: Obama Administration Releases National Action Plan to Combat Antibiotic-Resistant Bacteria. https://www.whitehouse.gov/the-press-office/2015/03/27/fact-sheet-obama-administration-releases-national-action-plan-combat-ant - The White House. March 2015 National Action Plan for Combatting Antibiotic Resistant Bacteria. https://www.whitehouse.gov/sites/default/files/docs/national_action_plan_for_combating_antibotic-resistant_bacteria.pdf
  11. Liu YY, Wang Y, Walsh TR et al Emergence of plasmid-mediated colistin resistance mechanism MCR-1 in animals and human beings in China: a microbiological and molecular biological study. Lancet Infect Dis. 2015 Nov 18. pii: S1473-3099(15)00424-7 PMID: 26603172 http://www.thelancet.com/journals/laninf/article/PIIS1473-3099%2815%2900424-7/abstract - Patersonl DL, Harris PN Colistin resistance: a major breach in our last line of defence. Lancet Infect Dis. 2015 Nov 18. pii: S1473-3099(15)00463-6 PMID: 26603171 http://www.thelancet.com/journals/laninf/article/PIIS1473-3099%2815%2900463-6/abstract
  12. Weiner LM, Fridkin SK, Aponte-Torres Z et al Vital Signs: Preventing Antibiotic-Resistant Infections in Hospitals - United States, 2014 MMWR Early Release / March 3, 2016 / 65 http://www.cdc.gov/mmwr/volumes/65/wr/mm6509e1er.htm
  13. Medical Knowledge Self Assessment Program (MKSAP) 17, American College of Physicians, Philadelphia 2015
  14. World Health Organization (WHO) Joint News release OPGA/WHO/FAO/OIE, Sept 21, 2016 At UN, global leaders commit to act on antimicrobial resistance. http://www.who.int/mediacentre/news/releases/2016/commitment-antimicrobial-resistance/en/
  15. World Health Organization (WHO). WHO publishes list of bacteria for which new antibiotics are urgently needed. News Release. Feb 27, 2017 http://www.who.int/mediacentre/news/releases/2017/bacteria-antibiotics-needed/en/
  16. Zhu YG, Zhao Y, Li B et al. Continental-scale population of estuaries with antibiotic resistance genes. Nat Microbiol 2017 Jan 30; 2:16270 PMID: 28134918 http://www.nature.com/articles/nmicrobiol2016270
  17. General Assembly of the United Nations High-Level Meeting on Antimicrobial Resistance Press Release. Sept 26, 2016 http://www.un.org/pga/71/2016/09/21/press-release-hl-meeting-on-antimicrobial-resistance/
  18. World Health Organization (WHO). The world is running out of antibiotics, WHO report confirms. WHO News Release. Sept 20, 2017 http://www.who.int/mediacentre/news/releases/2017/running-out-antibiotics/en/
  19. Carter GP, Schultz MB, Baines SL et al. Topical antibiotic use coselects for the carriage of mobile genetic elements conferring resistance to unrelated antimicrobials in Staphylococcus aureus. Antimicrob Agents Chemother 2018 Feb; 62:e02000 PMID: 29229636 Free PMC Article http://aac.asm.org/content/62/2/e02000-17
  20. Centers for Disease Control & Prevention (CDC) Biggest Threats and Data. CDC's Antibiotic Resistance Threats in the United States, 2019. https://www.cdc.gov/drugresistance/biggest-threats.html
  21. Madhusoodanan J Innovative tools take aim at antibiotic-resistant microbes. Nature Technology Feature. August 23, 2021 https://www.nature.com/articles/d41586-021-02292-1
  22. Drew L How antidepressants help bacteria resist antibiotics. A laboratory study unravels ways non-antibiotic drugs can contribute to drug resistance. Nature News. Jan 24, 2023 https://www.nature.com/articles/d41586-023-00186-y
  23. Tamma PD, Heil EL, Justo JA, Mathers AJ, Satlin MJ, Bonomo RA. Infectious Diseases Society of America 2024 Guidance on the Treatment of Antimicrobial-Resistant Gram-Negative Infections. Clin Infect Dis. 2024 Aug 7:ciae403. PMID: 39108079 https://academic.oup.com/cid/advance-article/doi/10.1093/cid/ciae403/7728556
  24. Antimicrobial (Drug) Resistance https://www.niaid.nih.gov/research/antimicrobial-resistance
  25. Antimicrobial Resistance Information from FDA. https://www.fda.gov/emergency-preparedness-and-response/mcm-issues/antimicrobial-resistance-information-fda
  26. Centers for Disease Control and Prevention (CDC) National Antimicrobial Resistance Monitoring System (NARMS) NARMS Now: Human Data (Interactive Tool) http://wwwn.cdc.gov/narmsnow/